| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,534 |
7,521 |
$424K |
| D1120 |
Prophylaxis - child |
9,076 |
9,056 |
$351K |
| D1351 |
Sealant - per tooth |
9,384 |
2,676 |
$256K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
3,510 |
1,960 |
$232K |
| D0230 |
Intraoral - periapical each additional radiographic image |
48,223 |
8,885 |
$195K |
| D2140 |
|
2,386 |
1,502 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,815 |
8,796 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,591 |
1,591 |
$100K |
| D0272 |
Bitewings - two radiographic images |
8,016 |
7,999 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
941 |
638 |
$54K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
393 |
299 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
1,559 |
1,543 |
$18K |
| D0145 |
Oral evaluation for a patient under three years of age |
200 |
200 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
99 |
82 |
$10K |
| D9430 |
|
243 |
240 |
$8K |
| D2160 |
|
94 |
64 |
$7K |
| D2335 |
|
19 |
13 |
$2K |